EP3087997A1 - Procédés de traitement de l'insuffisance cardiaque globale - Google Patents

Procédés de traitement de l'insuffisance cardiaque globale Download PDF

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EP3087997A1
EP3087997A1 EP16156504.9A EP16156504A EP3087997A1 EP 3087997 A1 EP3087997 A1 EP 3087997A1 EP 16156504 A EP16156504 A EP 16156504A EP 3087997 A1 EP3087997 A1 EP 3087997A1
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polypeptide
erbb2
nrg
use according
gene
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EP3087997B1 (fr
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Mark Marchionni
Ralph Kelly
Beverly Lorell
Douglas B. Sawyer
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Brigham and Womens Hospital Inc
Cenes Pharmaceuticals Inc
Beth Israel Deaconess Medical Center Inc
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Brigham and Womens Hospital Inc
Beth Israel Deaconess Medical Center Inc
Beth Israel Hospital Association
Cambridge Neuroscience Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1883—Neuregulins, e.g.. p185erbB2 ligands, glial growth factor, heregulin, ARIA, neu differentiation factor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
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    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
    • A61P25/32—Alcohol-abuse
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
    • A61P25/36—Opioid-abuse
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A—HUMAN NECESSITIES
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    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
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    • A—HUMAN NECESSITIES
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    • A61P5/00—Drugs for disorders of the endocrine system
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    • A—HUMAN NECESSITIES
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    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/12—Antihypertensives

Definitions

  • the filed of the invention is treatment and prevention of congestive heart failure.
  • Congestive heart failure one of the leading causes of death in industrialized countries, results from an increased workload on the heart and a progressive decrease in its pumping ability.
  • the increased workload that results from high blood pressure or loss of contractile tissue induces compensatory cardiomyocyte hypertrophy and thickening of the left ventricular wall, thereby enhancing contractility and maintaining cardiac function.
  • the left ventricular chamber dilates, systolic pump function deteriorates, cardiomyocytes undergo apoptotic cell death, and myocardial function progressively deteriorates.
  • Factors that underlie congestive heart failure include high blood pressure, ischemic heart disease, exposure to cardiotoxic compounds such as the anthracycline antibiotics, and genetic defects known to increase the risk of heart failure.
  • Neuregulins (NRGs) and NRG receptors comprise a growth factor-receptor tyrosine kinase system for cell-cell signalling that is involved in organogenesis in nerve, muscle, epithelia, and other tissues ( Lemke, Mol. Cell. Neurosci. 7: 247-262, 1996 and Burden et al., Neuron 18: 847-855, 1997 ).
  • the NRG family consists of three genes that encode numerous ligands containing epidermal growth factor (EGF)-like, immunoglobulin (Ig), and other recognizable domains. At least 20 (perhaps 50 or more) secreted and membrane-attached isoforms may function as ligands in this signalling system.
  • the receptors for NRG ligands are all members of the EGF receptor (EGFR) family, and include EGFR (or ErbB1), ErbB2, ErbB3, and ErbB4, also known as HER1 through HER4, respectively, in humans ( Meyer et al., Development 124: 3575-3586, 1997 ; Orr-Urtreger et al., Proc. Natl. Acad. Sci. USA 90: 1867-71, 1993 ; Marchionni et al., Nature 362: 312-8, 1993 ; Chen et al., J. Comp. Neurol.
  • EGFR EGF receptor
  • Nrg-1, Nrg-2, and Nrg-3 map to distinct chromosomal loci ( Pinkas-Kramarski et al., Proc. Natl. Acad. Sci. USA 91: 9387-91, 1994 ; Carraway et al., Nature 387: 512-516, 1997 ; Chang et al., Nature 387: 509-511, 1997 ; and Zhang et al., Proc. Natl. Acad. Sci. USA 94: 9562-9567, 1997 ), and collectively encode a diverse array of NRG proteins.
  • Nrg- 1 The most thoroughly studied to date are the gene products of Nrg- 1 , which comprise a group of approximately 15 distinct structurally-related isoforms ( Lemke, Mol. Cell. Neurosci. 7: 247-262, 1996 and Peles and Yarden, BioEssays 15: 815-824, 1993 ).
  • NRG-1 Neu Differentiation Factor
  • Heregulin HRG; Holmes et al., Science 256: 1205-1210, 1992
  • Acetylcholine Receptor Inducing Activity ARIA; Falls et al., Cell 72: 801-815, 1993
  • GGF1, GGF2, and GGF3 glial growth factors
  • Nrg-2 gene was identified by homology cloning ( Chang et al., Nature 387:509-512, 1997 ; Carraway et al., Nature 387:512-516, 1997 ; and Higashiyama et al., J. Biochem. 122: 675-680, 1997 ) and through genomic approaches ( Busfield et al., Mol. Cell. Biol. 17:4007-4014, 1997 ).
  • NRG-2 cDNAs are also known as Neural- and Thymus-Derived Activator of ErbB Kinases (NTAK; Genbank Accession No.
  • EGF-like domain is present at the core of all forms of NRGs, and is required for binding and activating ErbB receptors.
  • Deduced amino acid sequences of the EGF-like domains encoded in the three genes are approximately 30-40% identical (pairwise comparisons). Further, there appear to be at least two sub-forms of EGF-like domains in NRG-1 and NRG-2, which may confer different bioactivities and tissue-specific potencies.
  • NRGs Cellular responses to NRGs are mediated through the NRG receptor tyrosine kinases EGFR, ErbB2, ErbB3, and ErbB4 of the epidermal growth factor receptor family. High-affinity binding of all NRGs is mediated principally via either ErbB3 or ErbB4. Binding of NRG ligands leads to dimerization with other ErbB subunits and transactivation by phosphorylation on specific tyrosine residues. In certain experimental settings, nearly all combinations of ErbB receptors appear to be capable of forming dimers in response to the binding of NRG-1 isoforms. However, it appears that ErbB2 is a preferred dimerization partner that may play an important role in stabilizing the ligand-receptor complex. Recent evidence has shown that expression of NRG-1, ErbB2, and ErbB4 is necessary for trabeculation of the ventricular myocardium during mouse development.
  • neuregulins stimulate compensatory hypertrophic growth and inhibit apoptosis of myocardiocytes subjected to physiological stress. Our observations indicate that neuregulin treatment will be useful for preventing, minimizing, or reversing congestive heart disease resulting from underlying factors such as hypertension, ischemic heart disease, and cardiotoxicity.
  • the invention provides a method for treating or preventing congestive heart failure in a mammal.
  • the method involves administering a polypeptide that contains an epidermal growth factor-like (EGF-like) domain to the mammal, wherein the EGF-like domain is encoded by a neuregulin gene, and wherein administration of the polypeptide is in an amount effective to treat or prevent heart failure in the mammal.
  • EGF-like epidermal growth factor-like
  • the neuregulin gene may be the NRG-1 gene, the NRG-2 gene, or the NRG-3 gene.
  • the polypeptide may be encoded by any of these three neuregulin genes. Still further, the polypeptide used in the method may be recombinant human GGF2.
  • the mammal is a human.
  • the congestive heart failure may result from hypertension, ischemic heart disease, exposure to a cardiotoxic compound (e.g., cocaine, alcohol, an anti-ErbB2 antibody or anti-HER2 antibody, such as HERCEPTIN ® , or an anthracycline antibiotic, such as doxorubicin or daunomycin), myocarditis, thyroid disease, viral infection, gingivitis, drug abuse; alcohol abuse, periocarditis, atherosclerosis, vascular disease, hypertrophic cardiomyopathy, acute myocardial infarction or previous myocardial infarction, left ventricular systolic dysfunction, coronary bypass surgery, starvation, an eating disorder, or a genetic defect.
  • a cardiotoxic compound e.g., cocaine, alcohol, an anti-ErbB2 antibody or anti-HER2 antibody, such as HERCEPTIN ® , or an anthracycline antibiotic, such as doxorubicin or daunomycin
  • myocarditis thyroid disease
  • an anti-ErB2 or anti-HER2 antibody such as HERCEPTIN ® is administered to the mammal either before, during, or after anthracycline administration.
  • the polypeptide containing an EGF-like domain encoded by a neuregulin gene is administered before, during, or after exposure to a cardiotoxic compound. In yet other embodiments, the polypeptide containing the EGF-like domain is administered during two, or all three, of these periods.
  • the polypeptide is administered either prior to or after the diagnosis of congestive heart failure in the mammal.
  • the polypeptide is administered to a mammal that has undergone compensatory cardiac hypertrophy.
  • administration of the polypeptide maintains left ventricular hypertrophy, prevents progression of myocardial thinning, or inhibits cardiomyocyte apoptosis.
  • the polypeptide may be administered by administering an expression vector encoding the polypeptide to the mammal.
  • congestive heart failure impaired cardiac function that renders the heart unable to maintain the normal blood output at rest or with exercise, or to maintain a normal cardiac output in the setting of normal cardiac filling pressure.
  • a left ventricular ejection fraction of about 40% or less is indicative of congestive heart failure (by way of comparison, an ejection fraction of about 60% percent is normal).
  • Patients in congestive heart failure display well-known clinical symptoms and signs, such as tachypnea, pleural effusions, fatigue at rest or with exercise, contractile dysfunction, and edema.
  • Congestive heart failure is readily diagnosed by well known methods (see, e.g., " Consensus recommendations for the management of chronic heart failure.” Am. J. Cardiol., 83(2A):1A-38-A, 1999 ).
  • Relative severity and disease progression are assessed using well known methods, such as physical examination, echocardiography, radionuclide imaging, invasive hemodynamic monitoring, magnetic resonance angiography, and exercise treadmill testing coupled with oxygen uptake studies.
  • ischemic heart disease is meant any disorder resulting from an imbalance between the myocardial need for oxygen and the adequacy of the oxygen supply. Most cases of ischemic heart disease result from narrowing of the coronary arteries, as occurs in atherosclerosis or other vascular disorders.
  • myocardial infarction is meant a process by which ischemic disease results in a region of the myocardium being replaced by scar tissue.
  • cardiotoxic is meant a compound that decreases heart function by directing or indirectly impairing or killing cardiomyocytes.
  • hypertension blood pressure that is considered by a medical professional (e.g., a physician or a nurse) to be higher than normal and to carry an increased risk for developing congestive heart failure.
  • treating is meant that administration of a neuregulin or neuregulin-like polypeptide slows or inhibits the progression of congestive heart failure during the treatment, relative to the disease progression that would occur in the absence of treatment, in a statistically significant manner.
  • Well known indicia such as left ventricular ejection fraction, exercise performance, and other clinical tests as enumerated above, as well as survival rates and hospitalization rates may be used to assess disease progression.
  • Whether or not a treatment slows or inhibits disease progression in a statistically significant manner may be determined by methods that are well known in the art (see, e.g., SOLVD Investigators, N. Engl. J. Med. 327:685-691, 1992 and Cohn et al., N. Engl. J. Med. 339:1810-1816, 1998 ).
  • preventing is meant minimizing or partially or completely inhibiting the development of congestive heart failure in a mammal at risk for developing congestive heart failure (as defined in “ Consensus recommendations for the management of chronic heart failure.” Am. J. Cardiol., 83(2A):1A-38-A, 1999 ). Determination of whether congestive heart failure is minimized or prevented by administration of a neurgulin or neuregulin-like polypeptide is made by known methods, such as those described in SOLVD Investigators, supra , and Cohn et al., supra.
  • At risk for congestive heart failure is meant an individual who smokes, is obese (i.e., 20% or more over their ideal weight), has been or will be exposed to a cardiotoxic compound (such as an anthracycline antibiotic), or has (or had) high blood pressure, ischemic heart disease, a myocardial infarct, a genetic defect known to increase the risk of heart failure, a family history of heart failure, myocardial hypertrophy, hypertrophic cardiomyopathy, left ventricular systolic dysfunction, coronary bypass surgery, vascular disease, atherosclerosis, alcoholism, periocarditis, a viral infection, gingivitis, or an eating disorder (e.g., anorexia nervosa or bulimia), or is an alcoholic or cocaine addict.
  • a cardiotoxic compound such as an anthracycline antibiotic
  • decreasing progression of myocardial thinning is meant maintaining hypertrophy of ventricular cardiomyocytes such that the thickness of the ventricular wall is maintained or increased.
  • neuregulin treatment inhibits death of cardiomyocytes by at least 10%, more preferably by at least 15%, still more preferably by at least 25%, even more preferably by at least 50%, yet more preferably by at least 75%, and most preferably by at least 90%, compared to untreated cardiomyocytes.
  • NRG neurotrophic factor
  • neutral protein-1 By “neuregulin-1,” “NRG-1,” “heregulin,” “GGF2,” or “p185erbB2 ligand” is meant a polypeptide that binds to the ErbB2 receptor and is encoded by the p185erbB2 ligand gene described in USPN 5,530,109 ; USPN 5,716,930 ; and USSN 08/461,097 .
  • neurotrophin-like polypeptide is meant a polypeptide that possesses an EGF-like domain encoded by a neuregulin gene, and binds to and activates ErbB-2, ErbB-3, ErbB-4, or a combination thereof.
  • EGF-like domain a polypeptide motif encoded by the NRG-1, NRG-2, or NRG-3 gene that binds to and activates ErbB2, ErbB3, ErbB4, or combinations thereof, and bears a structural similarity to the EGF receptor-binding domain as disclosed in Holmes et al., Science 256:1205-1210, 1992 ; USPN 5,530,109 ; USPN 5,716,930 ; USSN 08/461,097 ; Hijazi et al., Int. J. Oncol.
  • anti-ErbB2 antibody or "anti-HER2 antibody” is meant an antibody that specifically binds to the extracellular domain of the ErbB2 (also known as HER2 in humans) receptor and prevents the ErbB2 (HER2)-dependent signal transduction initiated by neuregulin binding.
  • ErbB2 also known as HER2 in humans
  • transformed cell is meant a cell (or a descendent of a cell) into which a DNA molecule encoding a neuregulin or polypeptide having a neuregulin EGF-like domain has been introduced, by means of recombinant DNA techniques or known gene therapy techniques.
  • promoter is meant a minimal sequence sufficient to direct transcription. Also included in the invention are those promoter elements which are sufficient to render promoter-dependent gene expression controllable for cell type or physiological status (e.g., hypoxic versus normoxic conditions), or inducible by external signals or agents; such elements may be located in the 5' or 3' or internal regions of the native gene.
  • operably linked is meant that a nucleic acid encoding a polypeptide (e.g., a cDNA) and one or more regulatory sequences are connected in such a way as to permit gene expression when the appropriate molecules (e.g., transcriptional activator proteins) are bound to the regulatory sequences.
  • expression vector is meant a genetically engineered plasmid or virus, derived from, for example, a bacteriophage, adenovirus, retrovirus, poxvirus, herpesvirus, or artificial chromosome, that is used to transfer a polypeptide (e.g., a neuregulin) coding sequence, operably linked to a promoter, into a host cell, such that the encoded peptide or polypeptide is expressed within the host cell.
  • a polypeptide e.g., a neuregulin
  • neuregulins promote survival and hypertrophic growth of cultured cardiac myocytes through activation of ErbB2 and ErbB4 receptors.
  • cardiomyocyte ErbB2 and ErbB4 levels are normal during early compensatory hypertrophy and decrease during the transition to early heart failure.
  • neuregulins are involved in stimulating compensatory hypertrophic growth in response to increased physiologic stress, as well as inhibiting apoptosis of myocardial cells subjected to such stress. These observations indicate that neuregulin treatment will be useful for preventing, minimizing, or reversing congestive heart disease. While not wishing to be bound by theory, it is likely that neuregulin treatment will strengthen the pumping ability of the heart by stimulating cardiomyocyte hypertrophy, and will partially or completely inhibit further deterioration of the heart by suppressing cardiomyocyte apoptosis.
  • Polypeptides encoded by the NRG-1, NRG-2, and NRG-3 genes possess EGF-like domains that allow them to bind to and activate ErbB receptors. Holmes et al. (Science 256: 1205-1210, 1992 ) has shown that the EGF-like domain alone is sufficient to bind and activate the p185erbB2 receptor.
  • any polypeptide product encoded by the NRG-1, NRG-2, or NRG-3 gene, or any neuregulin-like polypeptide e.g., a polypeptide having an EGF-like domain encoded by a neuregulin gene or cDNA (e.g., an EGF-like domain containing the NRG-1 peptide subdomains C-C/D or C-C/D', as described in USPN 5,530,109 , USPN 5,716,930 , and USSN 08/461,097 ; or an EGF-like domain as disclosed in WO 97/09425 ) may be used in the methods of the invention to prevent or treat congestive heart failure.
  • a polypeptide having an EGF-like domain encoded by a neuregulin gene or cDNA e.g., an EGF-like domain containing the NRG-1 peptide subdomains C-C/D or C-C/D', as described in USPN 5,530,109 , USPN 5,716,
  • Risk factors that increase the likelihood of an individual's developing congestive heart failure are well known. These include, and are not limited to, smoking, obesity, high blood pressure, ischemic heart disease, vascular disease, coronary bypass surgery, myocardial infarction, left ventricular systolic dysfunction, exposure to cardiotoxic compounds (alcohol, drugs such as cocaine, and anthracycline antibiotics such as doxorubicin, and daunorubicin), viral infection, pericarditis, myocarditis, gingivitis, thyroid disease, genetic defects known to increase the risk of heart failure (such as those described in Bachinski and Roberts, Cardiol. Clin.
  • neuregulins may be administered to prevent or decrease the rate of congestive heart disease progression in those identified as being at risk.
  • neuregulin administration to a patient in early compensatory hypertrophy may permit maintenance of the hypertrophic state and may prevent the progression to heart failure.
  • those identified to be at risk as defined above, may be given cardioproctive neuregulin treatment prior to the development of compensatory hypertrophy.
  • Neuregulin administration to cancer patients prior to and during anthracycline chemotherapy or anthracycline/anti-ErbB2 (anti-HER2) antibody (e.g., HERCEPTIN ® ) combination therapy may prevent the patients' cardiomyocytes from undergoing apoptosis, thereby preserving cardiac function. Patients who have already suffered cardiomyocyte loss may also derive benefit from neuregulin treatment, because the remaining myocardial tissue will respond to neuregulin exposure by displaying hypertrophic growth and increased contractility.
  • Neuregulins and polypeptides containing EGF-like domains encoded by neuregulin genes may be administered to patients or experimental animals with a pharmaceutically-acceptable diluent, carrier, or excipient, in unit dosage form.
  • Conventional pharmaceutical practice may be employed to provide suitable formulations or compositions to administer such compositions to patients or experimental animals.
  • any appropriate route of administration may be employed, for example, parenteral, subcutaneous, intramuscular, intracranial, intraorbital, ophthalmic, intraventricular, intracapsular, intraspinal, intracisternal, intraperitoneal, intranasal, aerosol, oral, or topical (e.g., by applying an adhesive patch carrying a formulation capable of crossing the dermis and entering the bloodstream) administration.
  • Therapeutic formulations may be in the form of liquid solutions or suspensions; for oral administration, formulations may be in the form of tablets or capsules; and for intranasal formulations, in the form of powders, nasal drops, or aerosols. Any of the above formulations may be a sustained-release formulation.
  • Formulations for parenteral administration may, for example, contain excipients, sterile water, or saline, polyalkylene glycols such as polyethylene glycol, oils of vegetable origin, or hydrogenated napthalenes. Sustained-release, biocompatible, biodegradable lactide polymer, lactide/glycolide copolymer, or polyoxyethylene-polyoxypropylene copolymers may be used to control the release of the compounds.
  • Other potentially useful parenteral delivery systems for administering molecules of the invention include ethylene-vinyl acetate copolymer particles, osmotic pumps, implantable infusion systems, and liposomes.
  • Formulations for inhalation may contain excipients, for example, lactose, or may be aqueous solutions containing, for example, polyoxyethylene-9-lauryl ether, glycocholate and deoxycholate, or may be oily solutions for administration in the form of nasal drops, or as a gel.
  • Neuregulins and neuregulin-like polypeptides containing neuregulin EGF-like domains may also be administered by somatic gene therapy.
  • Expression vectors for neuregulin gene therapy e.g., plasmids, artificial chromosomes, or viral vectors, such as those derived from adenovirus, retrovirus, poxvirus, or herpesvirus
  • the promoter may be any non-tissue-specific promoter known in the art (for example, an SV-40 or cytomegalovirus promoter).
  • the promoter may be a tissue-specific promoter, such as a striated muscle-specific, an atrial or ventricular cardiomyocyte-specific (e.g., as described in Franz et al., Cardiovasc. Res. 35:560-566, 1997 ), or an endothelial cell-specific promoter.
  • the promoter may be an inducible promoter, such as the ischemia-inducible promoter described in Prentice et al. (Cardiovasc. Res. 35:567-574, 1997 ).
  • the promoter may also be an endogenous neuregulin promoter.
  • the expression vector may be administered as naked DNA mixed with or conjugated to an agent to enhance the entry of the DNA into cells, e.g., a cationic lipid such as LipofectinTM LipofectamineTM (Gibco/BRL, Bethesda, MD), DOTAPTM (Boeringer-Mannheim, Indianapolis, IN) or analogous compounds, liposomes, or an antibody that targets the DNA to a particular type of cell, e.g., a cardiomyocyte or an endothelial cell.
  • a cationic lipid such as LipofectinTM LipofectamineTM (Gibco/BRL, Bethesda, MD), DOTAPTM (Boeringer-Mannheim, Indianapolis, IN) or analogous compounds, liposomes, or an antibody that targets the DNA to a particular type of cell, e.g., a cardiomyocyte or an endothelial cell.
  • a cationic lipid such as LipofectinTM LipofectamineTM
  • DNA for somatic gene therapy has been successfully delivered to the heart by intravenous injection, cardiac perfusion, and direct injection into the myocardium (e.g., see Losordo et al., Circulation 98:2800-2804, 1998 ; Lin et al., Hypertension 33:219-224, 1999 ; Labhasetwar et al., J. Pharm. Sci. 87:1347-1350, 1998 ; Yayama et al., Hypertension 31:1104-1110, 1998 ).
  • the therapeutic DNA is administered such that it enters the patient's cells and is expressed, and the vector-encoded therapeutic polypeptide binds to and activates cardiomyocyte ErbB receptors.
  • Neonatal rat ventricular myocyte (NRVM) primary cultures were prepared as described previously ( Springhorn et al., J. Biol. Chem. 267: 14360-14365, 1992 ). To selectively enrich for myocytes, dissociated cells were centrifuged twice at 500 rpm for 5 min, pre-plated twice for 75 min, and finally plated at low density (0.7 - 1 X 104 cells/cm 2 ) in Dulbecco's modified Eagle's (DME) medium (Life Technologies Inc., Gaithersburg, MD) supplemented with 7% fetal bovine serum (FBS) (Sigma, St. Louis, MO).
  • DME Dulbecco's modified Eagle's
  • FBS fetal bovine serum
  • Cytosine arabinoside (AraC; 10 ⁇ M; Sigma) was added to cultures during the first 24-48 h to prevent proliferation of non-myocytes, with the exception of cultures used for thymidine uptake measurements. Unless otherwise stated, all experiments were performed 36-48 h after changing to a serum-free medium, DME plus ITS (insulin, transferrin, and selenium; Sigma). Using this method, we routinely obtained primary cultures with >95% myocytes, as assessed by microscopic observation of spontaneous contraction and by immunofluorescence staining with a monoclonal anti-cardiac myosin heavy chain antibody (anti-MHC; Biogenesis, Sandown, NH).
  • anti-MHC monoclonal anti-cardiac myosin heavy chain antibody
  • ARVM adult rat ventricular myocyte
  • ErbB2A 5'-TGTGCTAGTCAAGAGTCCCAACCAC-3': sense; SEQ ID NO: 1) and ErbB2B (5'-CCTTCTCTCGGTAC TAAGTATTCAG-3': antisense; SEQ ID NO: 2) for amplification of ErbB2 codon positions 857 to 1207 ( Bargmann et al., Nature 319: 226-230, 1986 ); ErbB3A (5'-GCTTAAAGTGCTTGGCTCGGGTGTC-3': sense; SEQ ID NO: 3) and ErbB3B (5'-TCCTACACACTGACACTTTCTCTT-3': antisense; SEQ ID NO: 4) for amplification of ErbB3 codon positions 712 to 1085 ( Kraus et al., Proc.
  • RNA samples (1 ⁇ g) from rat hearts or freshly isolated neonatal and adult rat ventricular myocytes were reverse-transcribed to generate first-strand cDNA.
  • the PCR reactions were performed in a final volume of 50 ⁇ l containing approximately 50 ng of first-strand cDNAs for thirty cycles in a PTC-100TM Programmable Thermal Controller (MJ Research, Inc.; Watertown, MA). Each cycle included 30 sec at 94° C, 75 sec at 63° C, and 120 sec at 72° C. Thirty ⁇ l aliquots of each reaction mixture were analyzed by electrophoresis in 1% agarose gels and by ethidium bromide staining. The PCR products were directly cloned into the TA cloning vector (Invitrogen Co., San Diego, CA) and verified by automatic DNA sequencing.
  • TA cloning vector Invitrogen Co., San Diego, CA
  • rhGGF2 human glial growth factor 2
  • Cells were quickly rinsed twice with ice-cold phosphate-buffered saline (PBS) and lysed in cold lysis buffer containing 1% NP40, 50 mM Tris-HCl (pH 7.4), 150 mM NaCl, 1 mM ethylene glycol-bis( ⁇ -aminoethyl ether)-N, N, N', N'-tetraacetic acid (EGTA), 1 mM ethylenediaminetetraacetic acid (EDTA), 0.5% sodium deoxycholate, 0.1% SDS, 1 mM sodium orthovanadate, 10 mM sodium molybdate, 8.8 g/L sodium pyrophosphate, 4 g/L NaFl, 1 mM phenylmethylsulfonyl fluoride (PMSF), 10 ⁇ g/ml aprotinin, and 20 ⁇ M leupeptin.
  • PBS ice-cold phosphate-buffered saline
  • Lysates were centrifuged at 12,000 X g at 4°C for 20 min, and aliquots of 500 ⁇ g (neonatal myocytes) or 2000 ⁇ g (adult myocytes) of supernatant were incubated with antibody specific to ErbB2 or ErbB4 (Santa Cruz Biotechnology Inc., Santa Cruz, CA) overnight at 4° C and precipitated with protein A-agarose (Santa Cruz Biotechnology, Inc.). Immunoprecipitates were collected and released by boiling in sodium dodecyl sulfate (SDS) sample buffer.
  • SDS sodium dodecyl sulfate
  • Samples were fractionated by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), transferred to polyvinylidene difluoride (PVDF) membranes (Biorad Laboratories, Hercules, CA) and probed with a PY20 antiphosphotyrosine antibody (Santa Cruz Biotechnology, Inc.).
  • PVDF polyvinylidene difluoride
  • the supernatants were also immunoprecipitated with a biotinylated RC20 antiphosphotyrosine antibody (Upstate Biotechnology, Inc., Lake Placid, NY) and blotted with a monoclonal antibody to ErbB2 (Ab-2; Oncogene Research Products, Cambridge, MA).
  • [ 3 H]thymidine incorporation was measured as described previously ( Berk et al., Hypertension 13:305-314, 1989 ). After incubation for 36 to 48 h in serum-free medium (DME plus ITS), the cells were stimulated with different concentrations of rhGGF2 (Cambridge NeuroScience Co., Cambridge, MA) for 20 h. [ 3 H]thymidine (0.7 Ci/mmol; Dupont) was then added to the medium at a concentration of 5 ⁇ Ci/ml and the cells were cultured for another 8 h. Cells were washed with PBS twice, 10% TCA once, and 10% TCA was added to precipitate protein at 4° C for 45 min.
  • the rate of [ 3 H]leucine uptake was used as an index of protein synthesis.
  • 10 ⁇ M cytosine arabinoside was added to the culture medium.
  • Cells were grown in serum-free medium for 36 to 48 h and then stimulated with different doses of rhGGF2.
  • [ 3 H]leucine (5 ⁇ Ci/ml) was added for 8 h, and cells were washed with PBS and harvested with 10% TCA. TCA-precipitable radioactivity was determined by scintillation counting as above.
  • rhGGF2 For examination of changes in myocyte phenotype with rhGGF2, cells were fixed in 4% (w/v) paraformaldehyde for 30 min at room temperature, rinsed with PBS, permeabilized with 0.1 % Triton X-100 for 15 min, and then incubated with 1% FBS for another 15 min, followed by incubation with anti-MHC (1:300) and visualized with TRITC-conjugated (NRVM) or FITC-conjugated (ARVM) second antibody.
  • NRVM TRITC-conjugated
  • ARVM FITC-conjugated
  • TdT terminal deoxynucleotidyltransferase
  • TUNEL dUTP nick end-labeling
  • Flow cytometric analysis of neonatal myocytes fixed in 70% ethanol/PBS and stained with propidium iodide was also performed to quantify the percentage of cells undergoing apoptosis. This method is based upon the observation that cells undergoing apoptosis have a hypo-diploid quantity of DNA and localize in a broad area below the G0/G1 peak on a DNA histogram. Briefly, cells were collected by trypsinization, pooled with nonattached cells, and fixed in 70% ethanol. After being rinsed once with PBS, cells were incubated with a propidium iodide (20 ⁇ g/ml, Sigma) solution containing RNase A (5 Kunitz units/ml) at room temperature for 30 min. Data were collected using a FACScan (Becton-Dickinson, San Jose, CA). For each sample, 10,000 events were collected. Aggregated cells and extremely small cellular debris were gated out.
  • a propidium iodide (20 ⁇ g/
  • rat prepro-atrial natriuretic factor prepro-ANF; a marker of cardiomyocyte hypertrophy
  • rat skeletal ⁇ -actin 240 bp of a 3'-untranslated region
  • a rat glyceraldehyde-3-phosphate dehydrogenase (GAPDH; a housekeeping gene) cDNA probe (240 bp of the coding region) was used as control for loading and transfer efficiency.
  • Ascending aortic stenosis was performed in male Wistar weanling rats (body weight 50-70 g, 3-4 weeks, obtained from Charles River Breeding Laboratories, Wilmington, Mass), as previously described ( Schunkert et al., Circulation, 87:1328-1339, 1993 ; Weinberg et al. Circulation, 90:1410-1422, 1994 ; Feldman et al., Circ. Res., 73:184-192, 1993 ; Schunkert et al., J. Clin. Invest.
  • Sham-operated animals served as age-matched controls.
  • the cell suspension was then incubated with antibodies against ⁇ -sarcomeric actin (mAb, Sigma, 1:20) and von Willebrand Factor (pAb, Sigma, 1:200) to distinguish between myocytes and endothelial cells.
  • Secondary antibodies goat anti-rabbit, goat anti-mouse pAb, Molecular probes, 1:400
  • Texas Red or Oregon Green
  • RT-PCRs reverse transcription-polymerase chain reactions
  • the latter primers recognize nucleic acids encoded by the NRG-1 gene, but do not discriminate between its isoforms.
  • the amplification was initiated by 1 min of denaturation, 2 min of annealing at the gene specific temperature and 2 min extension at 72° C.
  • the whole PCR reaction was electrophoresed on a 1% agarose gel and the PCR products of expected size were gel-purified.
  • the ß-actin probe provided by the kit was transcribed with T7 or T3 polymerase and resulted in a 330 and 300bp fragment, respectively. 20 ⁇ g of total RNA was hybridized to 5x10 5 cpm of ErbB2, ErbB4 or neuregulin c-RNA together with 2x10 4 cpm of ß-actin for later normalization according to the RPA II kit (Ambion) protocol.
  • proteins were transferred to a nitrocellulose membrane at 100 mA overnight.
  • the filters were blocked with 0.05%Tween-20, 5% nonfat milk and then incubated with anti-ErbB2 or anti-ErbB4 (Santa Cruz Biotechnology, each diluted 1:100, 1 ⁇ g/ml).
  • anti-ErbB2 or anti-ErbB4 Santa Cruz Biotechnology, each diluted 1:100, 1 ⁇ g/ml.
  • blots were subjected to the enhanced chemiluminescent (ECL) detection method (Amersham, Life Science) and afterwards exposed to Kodak MR film for 30-180 seconds.
  • ECL enhanced chemiluminescent
  • cryostat sections of left ventricular tissue were used for in situ hybridizations.
  • Antisense and sense RNA probe was synthesized from cDNA fragments in pBluescript with either T7 or T3 RNA polymerase and digoxigenin-labeled UTP (DIG RNA Labeling Mix, Boehringer Mannheim).
  • Tissue sections were first treated with 4% paraformaldehyde for 20 minutes, followed by 30 minutes digestion with proteinase K (10 ⁇ g/ml) at 37°C and another 5 minutes of fixation in 4% paraformaldehyde.
  • the slides were washed in PBS three times for 5 minutes, after which the sections were immersed in 0.1 M triethanolamine chloride buffer with 0.25% acetic anhydride for 10 minutes to block polar and charged groups on the section and hence prevent nonspecific probe binding.
  • 2X SSC After washing the slides in 2X SSC, they were then prehybridized (50% formamide, 2X SSC, 5% dextransulfate, 0.1% SDS, 1X Denhardt's, 400 ⁇ g/ml denatured salmon sperm DNA) at 45° C for 60 minutes in a moist chamber charged with 50% formamide/2X SSC. After 1 hour, the probes were added to the prehybridization solution and the slides were hybridized for 16-18 hours at 45°C.
  • TBS I buffer 100 mM Tris, 150 mM NaCl, pH 7.5
  • blocking reagent for 30 minutes at room temperature according to the manufacturer's protocol (DIG Nucleic Acid Detection Kit, Boehringer Mannheim).
  • the slides were immersed in TBS I for 1 minute and then the anti-DIG-AP conjugate solution (DIG Nucleic Acid Detection Kit, Boehringer Mannheim) was applied to each section for 1.5 hours at room temperature in a humid chamber. Afterwards, the slides were washed in TBS I three times, 10 minutes per wash, to wash off the excess antibody and equilibrated in TBS II (100 mM Tris, 100 mM NaCl, pH 9.5, 50 mM MgCl 2 •7H20) for 5 minutes. The color substrate was prepared according to the manufacturer's instructions and applied to each section until a blue-colored reaction became visible. The reaction was stopped and the slides were washed in PBS and distilled water for 5 minutes each. After a nuclear counter-staining the sections were dehydrated through an ethanol series, immersed in xylene and mounted by cover-slipping in Permount.
  • DIG Nucleic Acid Detection Kit Boehringer Mannheim
  • Fig. 1A shows the semiquantitative RT-PCR analysis of neuregulin receptor mRNA levels during cardiac development.
  • RNA from embryonic (E14, E16, and E19), neonatal (P1) or adult (Ad) rat heart, and from freshly isolated neonatal rat ventricular myocytes (NRVM) or adult rat ventricular myocytes (ARVM) was reverse-transcribed into cDNA and amplified with receptor isoform-specific primers (see Methods).
  • GAPDH was used as a control for reverse transcription, PCR amplification, and gel loading ("M” denotes 1 kb or 120 bp DNA molecular weight standards).
  • M denotes 1 kb or 120 bp DNA molecular weight standards
  • ErbB4 All three ErbB receptors were expressed in the developing rat heart at mid-embryogenesis (E14), with the following rank order of their relative mRNA abundances: ErbB4 > ErbB2 > ErbB3.
  • E16 and E19 and at post-natal day 1 (P1), only ErbB2 and ErbB4 mRNAs could be detected.
  • ErbB4 was still detectable, but its mRNA abundance was lower than that detected in embryonic and neonatal hearts, whereas ErbB2 mRNA and, rarely, ErbB3 mRNA could be detected only at low levels in adult myocardium.
  • ErbB4 receptor protein was immunoprecipitated with an anti-ErbB4 antibody from 500 ⁇ g of NRVM lysates or 2000 ⁇ g of ARVM lysates, and phosphorylated form of ErbB4 was detected by an anti-phosphotyrosine antibody.
  • the blot shown in Fig. 1B is representative of 3 independent experiments. As shown in Fig.
  • phosphorylated ErbB4 is quite prominent in neonatal myocytes and less robust, but detectable, in adult myocytes, which is consistent with the levels of ErbB4 mRNA abundance we observed above. Phosphorylated forms of ErbB2 and ErbB3 could not be detected even if immunoprecipitated with biotinylated-antiphosphotyrosine antibody, consistent with the much-reduced mRNA abundances for these two neuregulin receptors in post-natal cardiac myocytes.
  • GGF2 Stimulates DNA Synthesis in Neonatal Rat Ventricular Myocytes
  • Fig. 2A shows myocyte myosin heavy chain in NRVM, visualized with a TRITC-conjugated goat anti-mouse antibody (red).
  • Fig. 2B shows BrdU-positive nuclei visualized with a fluorescein-conjugated mouse anti-BrdU antibody (green).
  • the scale bar for Figs. 2A and 2B is equilvalent to 10 ⁇ m.
  • Fig. 2C shows the percentage of BrdU-positive myocytes under control conditions and in the presence of GGF2 (data are mean ⁇ SD for 3 experiments. * , p ⁇ 0.01). As displayed in Fig.
  • rhGGF2 40 ng/ml (approximately 0.7 nM) of rhGGF2 increased the percentage of BrdU-labelled myocytes (from postnatal day 1 rat heart ventricles) by about 80%, an increase in magnitude that was similar to that observed with [ 3 H]thymidine incorporation ( Fig. 3A ).
  • Figs. 3A and 3B show the effects of GGF2 on DNA synthesis in myocyte-enriched and non-myocyte fractions from rat ventricular myocyte primary isolates.
  • NRVM-enriched primary isolates or a "non-myocyte"-enriched fraction were exposed to control (i.e., serum-free) medium alone (Ctl) or to medium containing either 40 ng/ml rhGGF2 (GGF) or 7% fetal bovine serum (FBS).
  • control i.e., serum-free
  • GGF 40 ng/ml rhGGF2
  • FBS fetal bovine serum
  • DNA synthesis was assessed by [ 3 H]thymidine incorporation, and the data are expressed as relative cpm/dish normalized to the mean cpm of control cells in each experiment (mean ⁇ SD of triplicate analyses from three independent experiments; *, p ⁇ 0.01 vs control).
  • Twenty ng/ml of rhGGF2 provoked an approximate 60% increase in [ 3 H]thymidine incorporation into NRVM, which was about half that observed with 7% FBS.
  • the mitogenic effect of rhGGF2 on NRVM was concentration-dependent, with about an 80% increase at 50 ng/ml (i.e., 0.9 nM) ( Fig. 3B ).
  • GGF2 had similar mitogenic effects on BrdU or [ 3 H]thymidine incorporation on rat embryonic ventricular myocytes (E19) and postnatal ventricular myocytes (P5), whereas concentrations of GGF2 as high as 100 ng/ml had no effect on DNA synthesis in adult rat ventricular myocyte primary cultures.
  • rhGGF2 The effects of rhGGF2 on non-myocyte fractions obtained following the preplating steps of the neonatal rat ventricular myocyte isolation procedure also were investigated. As shown in Fig. 3A , rhGGF2 did not induce any significant change in [3H]thymidine incorporation into non-myocytes. This was in contrast to 7% FBS, which induced nearly a 10-fold increase in [ 3 H]thymidine incorporation into this cell population. Therefore, GGF2 shows a relatively specific action on cardiac myocytes compared to a myocyte-depleted cell population which, using the method of myocyte isolation we employed here, is composed largely of fibroblasts and endothelial cells.
  • DNA synthesis was measured in primary NRVM cultures after incubation with antibodies specific for ErbB2, ErbB3 and ErbB4.
  • Neonatal myocytes were cultured for two days in serum-free medium, after which they were treated for 30 h either without (control), or with rhGGF2 (10 ng/ml), or with rhFGF2 (20 ng/ml), or with GGF2/FGF2 and antibodies to ErbB2, ErbB3 or ErbB4, either alone or in combination as illustrated.
  • Antibodies (0.5 ⁇ g/ml/antibody) were preincubated with cells for 2 h before the addition of either GGF2 or FGF2.
  • a monoclonal antibody against the extracellular domain of c-neu/ErbB2 inhibited the GGF2-dependents increase in [ 3 H]thymidine incorporation into NRVM by GGF2 could be inhibited.
  • an antibody directed against the C-terminus of ErbB4 also blocked about 50% of the increase in [ 3 H]thymidine incorporation induced by GGF2.
  • a combination of these two antibodies had the same effect as either the anti-ErbB2 or anti-ErbB4 antibodies alone.
  • an antibody to ErbB3 had no effect on GGF2-induced DNA synthesis.
  • GGF2 Promotes Cardiac Myocyte Survival In Vitro
  • the survival effect of GGF2 was observed at 4 days in the continuous presence of cytosine arabinoside, with about 90% myocyte viability in the presence of 50 ng/ml rhGGF2 compared to approximately 70% viability in control cultures.
  • GGF2 had no significant effect on the survival of myocyte-depleted, "non-myocyte"-enriched primary isolates at 4 days.
  • the TUNEL-positive myocytes displayed cell shrinkage and chromatin condensation, which were also identified by Hoescht 33258-staining ( Fig. 6C and 6G ). Apoptosis was quantified either by counting the number of TUNEL-positive myocytes ( Fig. 6D ) or by flow cytometry analysis of the sub-G1 fraction following propidium iodine-staining of primary NRVM cultures that had been treated for 4 days with the indicated concentrations of rhGGF2 (H). The data shown for Fig. 6D and Fig. 6H are given as mean ⁇ S.D for three independent experiments. The scale bar in Figs. 6A-6C and 6E-6G represents 10 ⁇ M.
  • rhGGF2 (20 ng/ml)-treated adult myocyte cultures exhibited only about 3% TUNEL-positive staining ( Fig. 7B ). These results indicate neuregulins act as survival factors at least in part by preventing programmed cell death in both neonatal and adult ventricular myocytes.
  • GGF2 Induces Hypertrophic Growth of Cardiac Myocytes
  • FIGs. 8A and 8B show photomicrographs of subconfluent NRVM primary isolates incubated either without ( Fig. 8A ) or with ( Fig. 8B ) rhGGF2 (20 ng/ml) for 72 h in serum-free medium, after which cells were fixed and stained with an antibody to cardiac MHC (red, TRITC) and examined using indirect immunofluorescence microscopy.
  • the scale bar shown in the figure represents 10 ⁇ M.
  • NRVM neonatal cardiac myocytes
  • a hypertrophic response in cardiac myocytes is characterized by a number of phenotypic changes in addition to an increase in cell size, such as an increase in contractile protein content without cellular proliferation and the re-activation of an "embryonic" gene program. Therefore, we examined the effects of neuregulin on levels of prepro-ANF and skeletal ⁇ -actin mRNA (transcripts normally found in relatively low abundance in neonatal and adult ventricular myocytes), and on [ 3 H]leucine incorporation as an index of protein synthesis in NRVM primary cultures. Fig.
  • 8C shows a Northern blot analysis for prepro-ANF and skeletal ⁇ -actin mRNA from total RNA (20 ⁇ g/lane) from NRVM incubated either with or without rhGGF2 (20 ng/ml) for the times indicated. Equal loading and transfer of RNA were confirmed by GAPDH hybridization. RhGGF2 (20 ng/ml) increased mRNA levels for prepro-ANF and skeletal -actin within 60 min, approximately doubling by 16 h.
  • NVRM neurotrophic factor-like growth factor 2
  • serum-free medium for 24h, after which they were treated with the indicated concentrations of rhGGF2 for 40 h, and pulsed with [ 3 H]leucine for 8 h before termination of GGF2 stimulation.
  • GGF2 also caused hypertrophic responses in cultured adult rat ventricular myocytes (ARVM).
  • ARVM cultured adult rat ventricular myocytes
  • Primary cultures of ARVM were plated on coverslips in 24-well dishes and maintained for 5 days in ACCITT medium either without ( Fig. 9A ) or with rhGGF2 (20 ng/ml) ( Figs. 9B and 9C ).
  • Cells were fixed in 4% paraformaldehyde, stained with an antibody to myosin heavy chain (green, FITC), and examined by confocal microscopy. The scale bars represent 10 ⁇ M.
  • GGF2 also enhanced expression of prepro-ANF and skeletal ⁇ -actin in ARVM.
  • Primary isolates of ARVM were stimulated either with or without 20 ng/ml rhGGF2 for the times indicated.
  • Total RNA was isolated and analyzed by Northern blot (25 ⁇ g/lane) using prepro-ANF and skeletal ⁇ -actin cDNA probes. Equal loading and transfer conditions were confirmed by GAPDH hybridization. Phenylephrine (PE, 10 ⁇ M) was used as a positive control for hypertrophic growth. As shown in Fig.
  • rhGGF2 (20 ng/ml) doubled prepro-ANF mRNA abundance in ARVM primary cultures after 8 h, and this had increased 3- to 4-fold within 20 h.
  • An increase in skeletal ⁇ -actin mRNA abundance was also observed that was greater than that seen with phenylephrine (10 ⁇ M), an ⁇ -adrenergic agonist known to induce hypertrophic growth and reexpression of a number of fetal genes in adult rat ventricular myocytes.
  • phenylephrine 10 ⁇ M
  • skeletal ⁇ -actin mRNA levels were easily detectable, and increased by an additional 250% by 30 h treatment with GGF2.
  • GGF2 nor phenylephrine had any effect on GAPDH mRNA abundance under the conditions employed here.
  • GGF2 induced a dose-dependent increase in [ 3 H]leucine incorporation, with a 70% increase at a concentration of 5 ng/ml.
  • this neuregulin induces phenotypic changes consistent with hypertrophic adaptation in both neonatal and adult rat ventricular myocyte phenotypes at subnanomolar concentrations.
  • Example III ErbB2 and ErbB4 expression levels decrease in aortic stenosis rats in transition from chronic hypertrophy to early heart failure
  • left ventricular (LV) weight and the LV/body weight ratio were significantly (p ⁇ 0.05) increased in the 6-week and 22-week aortic stenosis animals compared with age-matched controls.
  • the in vivo LV systolic pressure was significantly increased in both 6-week and 22- week aortic stenosis animals compared with age-matched controls.
  • In vivo LV end-diastolic pressure was also higher in aortic stenosis animals compared to age-matched controls.
  • LV systolic developed pressure per gram was significantly higher in 6-week aortic stenosis animals in comparison with age-matched controls, but depressed in 22-week aortic stenosis animals.
  • the aortic stenosis animals also showed clinical markers of failure including tachypnea, small pleural and pericardial effusions. Table 1 .
  • Fig. 10A shows a ribonuclease protection assay demonstrating LV ErbB2 and ß-actin mRNA expression in 6-week aortic stenosis hearts and controls, and in 22-week aortic stenosis hearts and controls.
  • 10B shows a ribonuclease protection assay demonstrating LV ErbB4 and ß-actin mRNA expression in 6-week aortic stenosis hearts and controls, and 22-week aortic stenosis hearts and controls.
  • Steady state levels of ErbB2, ErbB4 and neuregulin mRNA levels in LV tissue from aortic stenosis rats and controls were then measured by ribonuclease protection assay (RPA) and normalized to ß-actin.
  • the LV neuregulin mRNA levels were not significantly different in tissue from 6-week aortic stenosis rats compared to age-matched controls (0.68 ⁇ 0.12 vs.
  • LV ErbB2 and ErbB4 mRNA levels which were normalized to levels of ß-actin, were preserved in 6-week aortic stenosis rats with compensatory hypertrophy relative to controls.
  • LV ErbB2 (p ⁇ 0.05) and ErbB4 (p ⁇ 0.01) message levels were significantly depressed in 22-week aortic stenosis rats at the stage of early failure ( Fig. 10 and Table 2).
  • RNA from LV myocytes of 6-week and 22-week aortic stenosis animals and controls The specificity of expression in myocytes was determined by examining message levels of atrial natriuretic peptide (ANP), a positive molecular marker of pressure overload hypertrophy, using myocyte RNA and normalization to levels of GAPDH.
  • Neuregulin was not detectable by RPA in RNA derived from myocytes in any group.
  • Fig. 12A shows a ribonuclease protection assay demonstrating LV myocyte ErbB2 and ß-actin mRNA expression in 6-weeks aortic stenosis hearts and controls, and 22-weeks aortic stenosis hearts and controls.
  • FIG. 12B shows a ribonuclease protection assay demonstrating LV myocyte ErbB4 and ß-actin mRNA expression in 6-week aortic stenosis hearts and controls, and 22-week aortic stenosis hearts and controls. Consistent with the measurements in LV tissues samples, cardiomyocyte ErbB2 and ErbB4 mRNA levels, normalized to ß-actin levels, are preserved relative to controls in 6-week aortic stenosis animals at the stage of compensatory hypertrophy (NS). However, both ErbB2 and ErbB4 expression are significantly downregulated in 22-week aortic stenosis animals at the transition to failure (p ⁇ 0.01).
  • FIG. 13A and 13B show Western blots showing LV ErbB2 and ß-actin protein levels in 6-week ( Fig. 13A ) aortic stenosis hearts and controls, and 22-week ( Fig. 13B ) aortic stenosis hearts and controls.
  • Figs. 13C and 13D show Western blots showing LV ErbB4 and ß-actin protein levels in 6-week ( Fig.
  • Example IV Inhibition of heart failure in aortic stenosis mice by polypeptides that contain a neuregulin-1 EGF-like domain
  • rhGGF2 suppresses apoptosis and stimulates cardiomyocyte hypertrophy in an ErbB2- and ErbB4-dependent fashion.
  • ErbB2 and ErbB4 receptors are down-regulated in the left ventricles of rats with pressure overload-induced heart failure.
  • Cardiomyocyte apoptosis is extremely rare during the early compensatory hypertrophic stage in aortic stenosis mice (i.e., 4 weeks after aortic banding), but consistently appears during the transition to early heart failure (i.e., 7 weeks after aortic banding).
  • One of ordinary skill in the art can readily determine the optimal dosage regimen required for providing prophylaxis against congestive heart disease or for slowing or halting progression of already-existent heart disease, using one of the many animals models for congestive heart failure that are known in the art.
  • the relative efficacy of a 0.3 mg/kg dose of GGF2 administered at early stages and late stages of cardiac disease in the aortic stenosis mouse model may be assessed as follows.
  • Example I Animals are sacrificed at the end of week 7. Prior to sacrifice, left ventricular hemodynamics are measured as described in Example I above, or using any standard protocol. Confocal microscopy may be used to quantitate myocyte growth (hypertrophy) and myocyte apoptosis by in situ nick-end labeling (TUNEL) or similar techniques for measuring cell death, using standard protocols or as described in Example I.
  • TUNEL in situ nick-end labeling
  • the optimal neuregulin dosage regimen e.g., amount of dose, frequency of administration, optimal time during the disease course to initiate neuregulin treatment
  • the optimal neuregulin dosage regimen e.g., amount of dose, frequency of administration, optimal time during the disease course to initiate neuregulin treatment
  • Example V NRG-1 inhibits anthracycline-induced apoptosis in rat cardiac myocytes
  • the anthracycline antibiotics e.g., daunorubicin, and doxorubicin
  • the anthracycline antibiotics have been a mainstay of cancer chemotherapy for more than 20 years.
  • the short- and long-term cardiotoxicity of these drugs limits both the individual dose and the cumulative dose that can be delivered to a patient.
  • anthracycline-induced cardiotoxicity There are two clinical types of anthracycline-induced cardiotoxicity.
  • the acute type which can occur after a single dose of anthracycline, is characterized by electrocardiographic changes, arrhythmias, and a reversible decrease in ventricular contractile function.
  • the chronic, delayed type is characterized by a largely irreversible decrease in ventricular contractile function which progresses to dilated cardiomyopathy and congestive heart failure. The incidence of this chronic cardiotoxicity is in direct proportion to the cumulative anthracycline dose.
  • GGF2 inhibits anthracycline-induced apoptosis in rat cardiac myocytes.
  • Fig. 14 shows that rat cardiomyocyte cultures pre-treated with IGF-1 or NRG-1 are less susceptible to apoptosis (indicated by TUNEL staining) induced by 1 ⁇ M daunorubicin.
  • IGF-1 this protective effect is rapid, and can be achieved within 30 minutes of pre-incubation, similar to what was reported for fetal cardiac myocytes. In contrast, this effect takes 24 hours of pre-incubation with NRG-1.
  • Fig. 15A shows that both IGF-1 and NRG-1 cause rapid phosphorylation of Akt ( Fig. 15A ), and that this is inhibited by the PI-3 kinase inhibitor wortmannin.
  • Akt has been implicated in mediating survival signals in some systems through phosphorylation and inactivation of the pro-apoptotic protein caspase 3. Either thirty minutes of pre-incubation with IGF-1 or 24 hours of pre-incubation with NRG-1 prevent anthracycline-induced activation of caspase 3. This effect, as well as the survival effect of IGF-1, is completely prevented by wortmannin ( Fig. 15B ).
  • NRG-1 effectively inhibits anthracycline-induced apoptosis. Therefore, NRG-1 could be used to limit or prevent cardiotoxicity in patients undergoing anthracycline chemotherapy and to treat patients that have congestive heart failure caused by cardiotoxicity induced by anthracyclines or other cardiotoxic agents.
  • These models may be used to determine the optimal neuregulin or neuregulin-like polypeptide treatment regimen (e.g., amount and frequency of dosage, and timing relative to anthracycline administration), for minimizing, preventing, or reversing anthracycline-induced cardiotocicity.
  • optimal neuregulin or neuregulin-like polypeptide treatment regimen e.g., amount and frequency of dosage, and timing relative to anthracycline administration
  • Example VI Neuregulin-dependent inhibition of cardiac failure induced by anthracycline/anti-ErbB2 (anti-HER2) combination therapy
  • ErbB receptors Various types of cancer cells display increased expression or increased biological activity of ErbB receptors. These transmembrane receptor tyrosine kinases bind growth factors belonging to the neuregulin (also known as heregulin) family. Expression of the ErbB2 receptor (also known as HER2 and neu) in cancer cells has been correlated with increases in proliferation of carcinoma cells derived from various tissues, including, but not limited to, breast, ovary, prostate, colon, pancreas, and salivary gland.
  • HERCEPTIN ® Trastuzumab; Genentech, Inc., South San Francisco, CA
  • HER2 humanized monoclonal antibody that specifically binds the extracellular domain of the human ErbB2 (HER2) receptor
  • HERCEPTIN ® a humanized monoclonal antibody that specifically binds the extracellular domain of the human ErbB2 (HER2) receptor
  • HERCEPTIN ® anti-ErbB2 antibodies
  • patients receiving combination therapy also suffered increased cardiotoxicity relative to patients receiving anthracycline therapy alone, indicating that anti-ErbB2 (anti-HER2) antibodies such as HERCEPTIN ® increase anthracycline-induced cardiotoxicity.
  • anti-HER2 anti-HER2 antibodies
  • HERCEPTIN ® increase anthracycline-induced cardiotoxicity.
  • patients that had previously been treated with doxorubicin and later received HERCEPTIN ® also showed an increased incidence of cardiotoxicity, relative to patients treated with doxorubicin alone.
  • Embodiments of the invention may include the features of the following enumerated paragraphs ("paras").

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